Provider Demographics
NPI:1922015569
Name:DIVENERE, PETER G (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:DIVENERE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-0185
Mailing Address - Country:US
Mailing Address - Phone:843-237-0432
Mailing Address - Fax:843-235-9141
Practice Address - Street 1:58 ALSTON RD
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-0185
Practice Address - Country:US
Practice Address - Phone:843-237-0432
Practice Address - Fax:843-235-9141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice